● Despite the adoption of UN Security Council Resolution 2401, which demands an immediate cessation of hostilities lasting for at least 30 days throughout Syria, escalating fighting reportedly continued in East Ghouta causing extensive civilian casualties and destruction of civilian infrastructure.

● Reports indicate that the overall number of civilians killed between 18 February and 11 March could have reached over 1,100 while over 4,000 injured have been reported.

● In March, intensive fighting and advancements by the Government of Syria (GoS) resulted in significant changes of control leading to new waves of internal displacement towards Duma, Arbin and Kafr Batna.

● A total of 77 priority cases out of over 1,000 sick and injured patients have been identified as being in need of urgent medical evacuation from East Ghouta.

● A UN/SARC/ICRC interagency convoy entered Duma amid ongoing violence on 5 and 9 March 2018 with food for 27,500 people, along with health and nutrition supplies. Many of the planned health supplies intended for Duma were not allowed to be loaded. The needs of affected people remain severe, across sectors including WASH, food, shelter/NFIs, health and protection.

● While a larger group of civilian evacuations began to take place on 11 March, protection concerns for the safe and voluntary exit of civilians remain.

Situation Overview

Since mid-February, the besieged area of East Ghouta witnessed a further escalation in hostilities, with reports of mounting civilian casualties as well as widespread damage and destruction to civilian infrastructure due to air and ground-based strikes. Some reports indicate that the overall number of civilians killed between 18 February and 11 March could have reached over 1,100 while over 4,000 people have been reportedly injured. Over the same period, shelling on Damascus city was reported to have killed 36 civilians and injured 350.

Despite the UN Security Council’s adoption of resolution 2401 on 24 February, which demanded an immediate cessation of hostilities lasting for at least 30 days throughout Syria to enable the delivery of humanitarian assistance and the evacuation of the critically sick and wounded, extensive civilian casualties and destruction of civilian infrastructure have persisted in East Ghouta. There are reports of alleged use of barrel bombs, incendiary weapons and of people suffering from injuries consistent with the effects of chlorine.

In February, there was a significant increase in the numbers of incidents of violence against health care in East Ghouta, with 28 attacks verified by the Health Cluster. These include 14 attacks on hospitals, 11 attacks on health centres, two attacks on ambulance stations and one attack on a medical warehouse. At least four health workers are reported to have been killed in Febuary. A hospital in Kafra Batna sub-district was reportedly hit twice. In addition to violence against health facilities, several NGO offices in the enclave were reportedly rendered out of service.

During the first week of March, following the start of a ground offensive on 25 February, intensive shelling and airstrikes hit several locations in East Ghouta (including Duma, Harasta, Kafr Batna, Arbin, Hammuriya, Jisreen, Ein Terma, Bait Sawa, Saqba and Hezzeh) with GoS and allied forces taking control of Nashabiyeh sub-district and Shifuniyeh subdistrict.

The change in control around 5 March caused the displacement of all civilians in the area towards Duma and Kafr Batna sub-districts. An estimated 60 per cent of previous Non-State Armed Groups (NSAG) controlled territory is now under GoS control.

These significant shifts in areas of control has casued further waves of internal displacement within East Ghouta as people move to areas perceived as less dangerous or seek to reunite with their extended families. The majority of the displaced people have remained in NSAG-controlled areas. An estimated 45 per cent of the population of East Ghouta now live in the northern part of the enclave, while the remaining 55 per cent are in the central and southern part, including between 15,000 and 18,000 people in East Harasta. The enclave was effectively cut into three parts on 11 March and movement of civilians between these areas has reportedly become impossible.

During this period, leaflets announcing exit routes for civilians to reach GoS controlled areas were circulated in the remaining NSAG controlled areas. In addition to the previously identified exit point in Wafideen camp, on 8 March, the GoS and Russian Federation announced the opening of another exit point in the southern part of the enclave in Jisreen/Mleha. However, with ongoing hostilities, the absence of protection guarantees for civilians, and reportedly due to NSAGs preventing the exit of civilians, only a Pakistani couple was able to be evacuated from East Ghouta on 1 March with the support of SARC; 126 people from Misraba were also reportedly evacuated on 11 March; and an estimated 147 civilians(including 8 medical cases) were evacuated on 13 March as observed by a UN team at the AlWafideen crossing.

Following the evacuation, a UN interagency mission to Dwair Pioneers Camp, the collective shelter that received East Ghouta evacuees, took place. During the mission, it was reported that on 11 March, 17 families arrived from Misraba (76 people) to the shelter and on 13 March, 26 families from Duma (147 people). SARC reported that 8 medical cases were transported directly to a hospital in Damascus. Families were assisted by SARC with NFIs, hygiene kits, and ready-to-eat food. Additional people are expected to arrive at the shelter from East Ghouta according to the Deputy Governor of Rural Damascus.

The UN Resident/Humanitarian Coordinator in Syria is providing support, within the SG’s Good Offices approach, to create conditions for a cessation of hostilities in eastern Ghouta as per UNSC Resolution 2401, and continues to call on all parties to facilitate medical evacuations, protect civilian, and for full, sustained and unimpeded humanitarian access to people in need throughout Syria. If further evacuations of civilians from east Ghouta are planned, the UN will be available to observe and provide assistance to them in the shelters where they will be hosted.

A total of 77 priority cases have been identified out of the over 1,000 sick and injured patients in need of urgent medical evacuation from East Ghouta, should there be only a limited window for medical evacuations. They are mainly women and children, and are in critical need of life-saving care.